Vascular Surgery

JM is a 54 yo female with c/o chronic abdominal pain, nausea and vomiting. 30- 40 lbs weight loss over the past several months. Also with short distance buttock/thigh claudication.

Vascular Surgery

Medical HistoryCAD s/p MI x 2, PTCAHTNHyperlipidemiaPVDTobacco use (50 pack year) / COPDHepatitis C / Polysubstance AbuseChronic pain syndromeHypothyroidismCVARheumatoid arthritisSeizure d/o

Vascular Surgery

Surgical History

Cesarean section x 3Appendectomy

Vascular Surgery

CT scan• Severe calicified atherosclerosis in the pararenal

aorta causing narrowing• Extensive calcified plaque extending into the

SMA (near occlusive) and L renal artery (occlusive)

• Calcified plaques near the celiac and R renal artery

• Calcified distal aorta/iliac vessels• L External iliac artery occlusion, R common iliac

artery stenosis

Vascular Surgery

Vascular Surgery

Vascular Surgery

Vascular Surgery

Vascular Surgery

Vascular Surgery

Vascular Surgery

Vascular Surgery

Vascular Surgery

• Treatment options?

Vascular Surgery

Operation

• Aortic endarterectomy• SMA/Celiac/Renal endarterectomies• Aortobifemoral artery reconstruction with

Dacron (14x7 mm)

Vascular Surgery

L RA

R RA

SMA

Celiac

Ao

Vascular Surgery

Vascular Surgery

Vascular Surgery

L RA

Vascular Surgery

SMA

L RA

Vascular Surgery

L RA

R RA

SMA

Vascular Surgery

Vascular Surgery

Hospital course

• Extubated on POD#4• Diet advanced on POD#5• Transferred to the floor on POD#6• Tolerated a regular diet without abdominal

pain. Ambulated without assistance. Bilateral 2+ DP pulses present

• Discharged on POD#9